been taking this combination for 10 days. Atrial Fibrillation diagnosed in Oct 2020.
Had Catheter Ablation June 2021. Taking Edoxaban 30mcg. Ablation worked fine until heatwaves brought extreme symptoms back. Cardiologist prescribed Bisoprolol 2.5 mcg. for 2 months. Then poss repeat of Ablation. Feeling extremely exhausted and unable to walk even short distances . Want my life back. Feeling really depressed.
Are you taking your Bisoprolol at least 2 hours away from your thyroid meds? I take Bisoprolol a few hours away from my Levo and T3 and it hasn't made any difference to how my thyroid meds are absorbed, my thyroid levels are the same as always.
Have you seen the AF Association forum here:
healthunlocked.com/afassoci...
Have you any idea where you are in terms of blood tests? Like FT4, TSH, FT3.
I wasn't diagnosed as having Atrial Fibrillation when first diagnosed and prescribed levothyroxine (T4).
I had severe palpitations that occurred mainly during the night and I had overnight recordings of heartbeats. The Cardiologist was puzzled and was contemplating putting an implant in my heart 'to see what was going on'.
Just around the same time I had T3 added to a reduced T4 and my palpitations resolved altogether. I no longer needed an implant nor to consult with Cardiologist.
I am now prescribed T3 alone and feel well and don't need any other medications but still take 1 bisopropol at bedtime.
You are on a low dose so it’s surprising you have these symptoms, they may be due to some other cause. The cardiologist should know what they are doing (more than me!) but you could ask if you could try a different beta blocker such as sotalol which steadies the heart without slowing it down.
presumably you know you must take levothyroxine on its own, on empty stomach and then nothing apart from water for at least an hour after
No other medications or supplements within 2 hours
You need FULL thyroid and vitamin testing
Do you ever come back to U.K.
Get full thyroid and vitamin testing done on next visit ?
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Do you have autoimmune thyroid disease?
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Recommended on here that all thyroid blood tests early morning, ideally before 9am
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
The low dose of bisoprolol is unlikely to be the cause of your fatigue. However atrial fibrillation can cause fatigue and heart failure. Additionally Edoxaban which is a blood thinner is a dirty drug and fatigue is a common side effect. If you can be got back in to sinus rhythm you could discontinue the Edoxaban . No doubt your cardiologist will do a routine screen of your blood to check Edoxaban has not caused bleeding and anaemia also.
I really think that a cardiologist will be able to diagnose and correctly treat any firm if heart condition. Dirty drug? Most medications have side-effects, and there us a balance between negative and positive outcomes. There are other blood-thinners available, but not all suit every condition and/or every individual. It is up to the consultant , in conjunction with the patient, to find the best way forward.
The term "dirty drug" is really not very informative, nor helpful.
What does Edoxaban affect other than Xa?
(The term "blood thinner" is often deprecated as it is inaccurate. Anti-coagulants do not thin blood. They reduce tendency to clot.)
The DOACs remain very new and we are still learning about side effects- which doctors are not always very good at reporting. Reports that apixaban can cause memory loss are worrying (ehealthme.com/ds/eliquis/me.... Edoxaban commonly causes fatigue and abnormal liver function and is more likely to cause serious bleeding than Apixaban. In elderly patients with impaired renal function doses are adjusted without reference to plasma levels- they are a shot in the dark.For many Warfarin may be a safer alternative and certainly the side effect profile is better understood than the much newer DOACs.
I speak with some knowledge here as I suffered major memory loss on Apixaban and had to stop work. Two months on Edoxaban and I suffered a major GI bleed and abnormal liver function tests.
That is both much more concerning and much more helpful.
Thank you.
There are actually 3 doses off edoxaban available 15mg, 30 mg and 60mg so there is lots of opportunity to adjust the dose for the elderly (I am one) and those with renal impairment. Also there is the opportunity to co-prescribe omeprazole (or similar) to protect the gastric lining in the elderly or those with a history of indigestion. However some doctors simply prescribe 60 mg Edoxaban without giving it a thought.Now there is an elephant trap waiting here and that is relying on eGFR to estimate renal function when this can substantially underestimate renal impairment and we should instead be using creatinine clearance . I will copy GOV.UK advice below.
"In addition, a recent cross-sectional study of data from 80 general practices in the UK[footnote 1] reviewed the application of prescribing recommendations in older people with reduced kidney function. Prescribing of drugs outside recommendations for use in patients with reduced kidney function was widespread for the 8 drugs analysed. The prescribed dose was too high for kidney function in up to 40% of people aged 65 years and older, and up to 80% of people aged 85 years and older. Use of eGFR overestimated kidney function for up to 28% of those aged 65 years and older, and up to 58% of those aged 85 years and older".
So the dose of DOAC needs to be considered much more carefully to reduce the incidence of upper GI bleeds and the burden this places on hospitals. And co-prescribing of omeprazole should be routinely considered.
I suspect that you might well get more than 50% of the benefit even while only taking 50% of the dose. Just coming up with a "that will do for everyone" dose is not, to me, a convincing approach.
To deal with it I had to stop Edoxaban for 3 days and go on double omeprazole. Restarted Edoxaban at 45 mg and am now down to 30mg.
My third Covid dose vaccine caused DVT and multiple pulmonary emboli and Apixaban was not strong enough to hold off the clots. But then my memory was failing so I swapped to Edoxaban after 6 months. It became obvious within a week that at the prescribed dose Edoxaban was massively more powerful as an anti-clotting agent than Apixaban (looked like Mike Tyson was brushing my teeth) - and then two months later led to a large upper GI bleed. I have largely navigated these changes myself since there is not widespread knowledge about how to manage DOAC's in the NHS or privately.
All my sympathy. I'm on apixaban reduced dose as I bleed so much on the anticoagulants. I still bleed but less. EP says its not effective on a half dose.....but I think do I end up seriously ill from internal bleeding or go half dose with less effect and who knows if it reduces risk of stroke. No one seems to have the answer. The alternative is an operation to stitch the part of the heart that has the potential to cause a clot. Am told emphatically that having Afib mean a 5x increase in stroke risk.....so not something to ignore and am told its for life.
I have been looking at dose response curves and the fact that the DOACS have anti platelet activity also. I have 2 things to say.
There is no perfect dose. What is extraordinary is that the pharmaceutical companies conned people to believe one size fits all without any monitoring.
The evidence is there is benefit in taking reduced doses but it's difficult to quantify because individuals vary so very much.
Thanks Lilou. That's helpful. Can only do what I can with the body I have! I'm not prepared to risk bleeding to death. Why is there this nonsense over anti coags but other drugs have the ability to vary the dose to suit the individual? It doesn't make sense. Ive been tempted a fair few times to stop taking them tbh. I find it scary that so little regard is given to how these anti coags leave people bleeding. And its glossed over...
If the bleeding is upper GI its very straightforward- omeprazole or the PPI's. The problems comes if its lower GI like old age and diverticular disease. We don't know what to do. So we need to balance things.
Currently its my teeth.....bleed like count dracula. Ive tried all sorts. Otherwise it has been GI. Am now GF and thats done a lot of healing so a lot better. It would be helpful if doctors helped patients to weigh up the pros and cons. As for me I think its a fine balance of what is better.....stroke or a bleed that might not be fixable.
Well the good news is that brushing your teeth causes bleeding shows two things.Firstly you are alive
Secondly its working but we cannot measure the benefit!
🤣😂 well am glad I'm alive! As for the count dracula look its not fashionable at the mo....but if big pharma gets it way could become a fashionable trend!
I cant help wondering though if its a sign my blood is already well anti coagulated I just don't need it. Am on a half dose. Tempted to half the tablets!
Serious money is involved. Billions of dollars.
Interested to hear that apixaban can cause memory loss. Unable to open this link.
Try thisehealthme.com/extended/ds/e...
There appears to be a problem with the link.ehealthme.com/extended/ds/e...
Thank you Lilou done a Google search and found article you referred to. Intend to find a more natural anticoagulant. Nattokinase looking promising. Been concerned about apixaban from day one as I have small vessel disease, SVD stage one which is linked to early stages of dementia. Recently admitted to a+e due to memory loss, and confusion. Was seen pretty quickly because at first doctor thought I had a stroke which was ruled out. Then doctor sent me for CT scan because he suspected a brain bleed because I take apixaban. CT scan did not detect a brain bleed. When I was admitted to a+e my BP was 210 when I left 4 hours later it was 230 but nothing was done about that. Thing is my memory has deteriorated, but question is: Is this due to apixaban or the SVD? On the other hand both could be contributing to my memory decline. Can't do anything about the SVD but apixaban I can.
Thank you
The paper below may be of particular interest to you.pubmed.ncbi.nlm.nih.gov/358...
Thank you Lilou.
So blood thinners have no place in small vessel disease ( unless you have AF)But there are things we can do.
Adopt mediterranean diet
Avoid processed carbs
Avoid alcohol tobacco cocaine Marijuana
Loose weight if over weight pre-diabetic or diabetic
Take regular aerobic exercise (not lifting weights)
Consider taking a statin
You cannot undo the damage but you can reduce further damage.
Your heart condition itself can be the cause if your symptoms, as I'm sure you know. However, some blood thinners and beta-blockers can have similar side-effects, so possibly a discussion with your consultant about alternatives could be a step forward.
Probably off topic completely but My mum 80 has Atrial fibrillation (AF) and is actually still in hospital past 2wks, they’re trying to help her find a suitable drug she’s been on blood thinners more than a decade… her lungs filled up with water as she’s not very mobile and likely an infection..,unfortunately running out of things to help her, Bisoprolol and digoxin both made her psoriasis flare up it’s not just skin condition as it’s a autoimmune it’s caused her to feel absolutely awful as it’s an inflammatory condition … amiodarone is being tried now and can actually cause hypothyroidism… my point is some drugs can exacerbate our pre existing conditions and this should be considered.Fine line what is best and in life saving times we have to have these drugs.
I have suspected my mum has Hypothyroidism/Hashimoto’s but she isn’t interested in testing nor coeliac disease, so Drs aren’t aware.
I have wondered if this area was looked at if anything would help her… I’ve mentioned to one of the consultants this week but only interested in her heart, not sure they saw the connection or ironically the drugs she’s on has iodine in them… maybe it’s too late for her as there’s slight damage to left ventricle, but minor apparently.
This is a big reason I’d prefer to be proactive in getting better through any natural ways first… pharmaceutical can be best thing since slice bread and unfortunately worse for some, many medications cause other problems.
I was on 5mcg bisoprolol for two years, during lockdown. At that point I was not diagnosed with AFib that came later. In all honesty I could not tolerate the fatigue, lethargy and heavy legs along with breathlessness I experienced on this low dose. At times I would split pill and take 2.5. Normally, I am quite active, walk for many miles each day but once I started this medication I struggled to walk a short distance, had to keep stopping and starting at a snail's pace. There was no pleasure at all in walking. Intermittently, I would stop taking the bisoprolol and was somewhat like my normal self 're walking. Was diagnosed with AFib Oct 2020...first episode. Prescribed apixaban, amlodipine on top of the bisoprolol which I had stopped taking. Symptoms mentioned above returned along with horrendous brain fog...I could not think of talk to anyone. Reached a point whereby I was seriously planning to end my own life. By chance found a forum about amlodipine. Most people who posted on this forum were much younger than me but their main side effects they complained about was the horrendous BRAIN FOG. Long story I am off the amlodipine and bisoprolol. Finally got to see a cardiologist April this year who prescribed different meds. I am lot better now but still aim to find a alternative natural remedy to replace apixaban. Hope this helps.
Hello thank you to all that have responded to my post and sorry that I have not replied until now. I have been quite unwell over the last few days. Decided to go to A&E and after lots of tests they eliminated the Bisoprolol. Tests showed extreme bradycardia. Stopped taking it last 2 days and definitely feel better. I now have an appointment with the Cardiologist to discuss repeat of the Ablation to address the extreme Tachycardia that prompted use of Bisoprolol
I have recently had Covid also and the doctors (seen no Cardio yet) all believe that a combination of the recent extreme heat and the Covid may be responsible for my current condition. I have a very bad chest infection also that has been adding to me feeling pretty poorly. Hopefully once I see the Cardiologist I should get some clearer answers.
So pleased your feeling much better now you off the bisoprolol. I would never ever take this medication again along with amlodipine. On the medication I was admitted to a+e far too many times over past two years with dangerously high BP or AFib. I do believe the medication actually contributed to admissions to a+e. For some reason they made both conditions much worse. Not had one admission to a+e since put on new meds in April despite having had a few episodes of AFib. Hope you get ablation sorted pretty soon. Good luck. Unfortunately, I have been told that I can't have ablation because I have an enlarged heart.
Completely sympathise. All the beta blockers made me ill but bisopronolol was the worst- my heart raced so fast & I felt so weak & dizzy I felt like I was dying. Id never take a beta blocker ever again. I have hypothyroidism & despite the denials I swear it interfered with my thyroid hormones conversion & uptake.
Like you waveylines, I would never take beta blocker again, felt like I was at deaths door. I have hypothyroidism due to thyroidectomy, but I have no idea if bisoprolol messed up thyroid hormones (conversion + uptake)...Was too ill, depressed and confused to care. However, after blood tests in a+e I would occasionally ask if my thyroid levels were ok and was told they were. Stupid question to ask anyone in NHS about thyroid levels anyway.
My experience is I went in to fast AF after each Covid vaccine- usually 5- 6 weeks later. To abort the episodes I took up to 20mg bisoprolol. I cannot recommend this as sensible.
I am overwhelmed by the responses I received here. Thank you all for so much information.
Is it not just nice everyone contributing their experiences and knowledge ? The internet can be quite ghastly but I am encouraged there are people of kindly and good intent here.
Levothyroxine combined with NDT?
Taking accidentally 200mcg instead 100 mcg this morning, harmful? 
given a loading dose of colecalciferol and 25 mcg levothyroxine
